Management Of Juvenile Rheumatoid Arthritis Research Articles

Total joint replacement in childhood arthritis

Juvenile rheumatoid arthritis poses a distinct challenge to pediatric rheumatologists and orthopedic surgeons. Recent developments in the medical management of juvenile rheumatoid arthritis have decreased the need for surgical intervention in this subset of patients; however, those patients who need surgery are often the most challenging cases due to their relatively small bone size, the complex deformity caused by soft tissue contractures, and the tendency for multiple joint involvement. Nonetheless, technologic improvements in implant design and surgical techniques have led to successful outcomes in otherwise debilitating conditions. A careful and coordinated approach to the surgical management of juvenile rheumatoid arthritis can lead to improved function and significant pain relief for children with rheumatoid arthritis.

Serum activity of joint destruction proteinases in management of juvenile rheumatoid arthritis

Serum activity of joint destruction proteinases in management of juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis.

Musculoskeletal problems account for the majority of initial complaints attended to by primary care physicians. It is likely that a child who eventually has juvenile rheumatoid arthritis diagnosed will initially be evaluated by a family physician or a pediatrician. Primary care physicians will play an increasingly important role in management of juvenile rheumatoid arthritis, as the availability of specialists in many communities is limited, and access to them may be further limited by managed care initiatives. This article offers a brief review of the definition and classification of juvenile rheumatoid arthritis and introduces a diagnostic algorithm to provide a simplified approach toward evaluating children with arthritis. Treatment and outcomes are summarized in text and graphic formats.

Cognitive-Behavioral Pain Management in Children With Juvenile Rheumatoid Arthritis

Decreasing chronic joint pain is a major goal in the management of juvenile rheumatoid arthritis. Cognitive-behavioral self-regulatory techniques were taught to children with juvenile rheumatoid arthritis to reduce musculoskeletal pain intensity and to facilitate better adaptive functioning. Subjects were 13 children between the ages of 4.5 and 16.9 years who had pauciarticular or systemic onset juvenile rheumatoid arthritis. Baseline data included an initial comprehensive assessment of pain, disease activity, and level of functional disability, as well as pain intensity ratings gathered over a 4-week period. Subjects were seen for eight individual sessions in which self-regulatory techniques (progressive muscle relaxation, guided imagery, meditative breathing) were taught, and parents were seen for two sessions in which key aspects of behavioral pain management techniques were reviewed. Results indicated that these techniques led to substantial reduction of pain intensity, which generalized to outside the clinic setting. Six- and 12-month follow-up data showed consistent decreases in pain as well as improved adaptive functioning. The data suggest that cognitive-behavioral interventions for pain are an effective adjunct to standard pharmacologic interventions for pain in patients with juvenile rheumatoid arthritis.

Advanced pharmacotherapy in the management of juvenile rheumatoid arthritis

Advanced pharmacotherapy in the management of juvenile rheumatoid arthritis

Biobehavioral factors in juvenile rheumatoid arthritis: Implications for research and practice

Juvenile rheumatoid arthritis is the most common connective tissue disease in children. Juvenile rheumatoid arthritis may best be conceptualized as a syndrome of diverse etiologies with three distinct types of disease onset: systemic, poly articular, and pauciarticular. The overall management of juvenile rheumatoid arthritis consists of a multidisciplinary approach to comprehensive care. Biobehavioral factors are delineated into four primary areas: therapeutic adherence, arthritic pain, psychosocial adjustment, and functional independence. To date, relatively little systematic biobehavioral research has been conducted in juvenile rheumatoid arthritis; however, the potential for the interdisciplinary biobehavioral approach to this pediatrie chronic disorder is quite evident.

Early experiences with auranofin in juvenile rheumatoid arthritis

Pharmacologic management of juvenile rheumatoid arthritis is only one of several modalities necessary for effective control. The stepping stones to proper management Include a planned long-range program, physical therapy with swimming, good health habits, and consultation with other health professionals who are part of the management team. Pharmacologic therapy includes nonsteroidal anti-inflammatory drugs initially, occasionally corticosteroids, and slow-acting antirheumatic drugs, including injectable gold when therapeutic response is inadequate. Early experiences with oral gold are reported here. Auranofin (triethylphosphine gold) was administered to 21 patients with juvenile rheumatoid arthritis during a segment I, open ended, open-label, noncontrolled trial designed to establish safety and preliminary efficacy. Initial dosage was 0.1 mg/kg per day; incremental increases to 0.2 mg/kg per day were allowed (with usual increase to 0.15 mg/kg per day). Aspirin (80 mg/kg per day) or tolmetin (20 to 40 mg/kg per day), or naproxen (400 to 600 mg/m 2 per day) were allowed as rapidly acting anti-inflammatory agents. Stable measurable plasma concentrations of gold were attained in all patients during the study. More than half the patients sustained clinically significant improvement (greater than 25 percent) with regard to the number and severity of joints with swelling, pain on motion, and tenderness. In nine of the 19 patients, the total number of joints with active arthritis decreased by at least 25 percent. All articular disease indices measured indicated improvement of group mean changes between the initial and final visit. Eleven of 16 patients with an elevated erythrocyte sedimentation rate showed decreases of at least 25 percent. The group given higher dosages had a greater proportion of responders in regard to decreases in erythrocyte sedimentation rate (nine of 11 patients). Four of six patients whose serums contained rheumatoid factor showed decreases in the titers. Discontinuation of auranofin was necessary in two patients: one because of headache and one because of hematuria and anemia associated with a severe flare-up of polyarticular disease. The results from this trial reveal sufficient patient improvement to plan a double-blind trial of auranofin in children with juvenile rheumatoid arthritis.

Gold therapy in the management of juvenile rheumatoid arthritis.

Gold therapy for 6 months was shown to be efficacious in reducing the severity of articular manifestations in 32 (63%) of 51 juvenile rheumatoid arthritis patients reviewed retrospectively. Similarly, reductions in the total number of involved joints were seen in 25 (49%) patients. Patients in whom a favorable response to therapy was noted had more severe joint involvement at the start of therapy than did nonresponders. In general, patients who responded experienced considerable improvement. Duration of disease prior to gold therapy initiation and disease onset type were not related to the probability of favorable response. Incidence of adverse side effects was low. Gold has recently been approved by the Food and Drug Administration for use in children.

The Combined Pediatric-Orthopedic Approach to the Management of Juvenile Rheumatoid Arthritis

The Combined Pediatric-Orthopedic Approach to the Management of Juvenile Rheumatoid Arthritis